As U.S. waistlines expand, seatbelt use falls

NEW YORK (Reuters Health) - Obese drivers may be at a
strikingly higher risk of dying in car crashes than
normal-weight drivers because they frequently fail to buckle up,
a new study finds.

Based on analysis of a U.S. database of nearly 200,000 fatal
passenger vehicle crashes, researchers found that normal-weight
Americans involved in those accidents were 66 percent more
likely to have been wearing a seatbelt than those who were
severely obese.

"Cars should be designed so it's easier to put a seatbelt on
if you're obese," the study's lead author, Dr. Dietrich Jehle,
told Reuters Health.

"It's very important to increase seatbelt use in heavier
individuals to best prevent deaths on the highways," said Jehle,
who is director of emergency services at Erie County Medical
Center and vice chairman of Emergency Medicine at the State
University of New York at Buffalo.

Federal safety standards set in the 1960s, when Americans
tended to be lighter, require seatbelts to accommodate men up to
215 pounds. Some automakers provide larger belts or extenders,
Jehle said, but heavier people frequently struggle to fasten
their belts, feel squeezed once strapped in and drive unbelted.

An earlier study found that individuals considered morbidly
obese were 56 percent more likely to die in vehicle crashes than
people of normal weight.

Other research has shown that combined lap and shoulder
belts reduce crash deaths by 45 percent, Jehle and his
colleagues point out.

To see whether weight is linked to seatbelt use, Jehle's
group examined nearly 194,120 drivers involved in auto crashes
in which there was at least one fatality between 2003 and 2009.

It is the largest investigation to date of a connection
between seatbelt use and obesity, the researchers note in the
American Journal of Emergency Medicine.

Obesity is typically defined by body mass index (BMI), a
measure of weight relative to height. People with a BMI between
18.5 and 25 are considered normal weight. A BMI between 25 and
30 is considered overweight, between 30 and 40 is obese, and
above 40 is morbidly obese.

A 5-foot-10-inch tall man who weighed 300 pounds would have
a BMI of 43, for example.

One-third of Americans are considered overweight and another
third are considered obese, according to 2009 data from the
Centers for Disease Control and Prevention.

The new study relied on police reports and direct
observations about whether drivers involved in fatal traffic
accidents wore seatbelts.

Jehle's team found that the closer to morbid obesity a
person was, the less likely he or she was to have been wearing a
seat belt.

Compared to the morbidly obese drivers, moderately obese
people were 23 percent more likely to have been buckled up. The
slightly obese were 39 percent more likely and the overweight
were 60 percent more likely than the morbidly obese to have been
wearing a seatbelt.

"Not buckling up is a deadly decision," Jehle and his
colleagues write. "Obese drivers are far less likely to wear
seatbelts than are drivers of normal weight, which puts them at
a greater risk of being subjected to higher impact forces and
being ejected from the vehicle, both of which lead to more
severe injury and/or death."

Peggy Howell, a spokeswoman for the National Association to
Advance Fat Acceptance, agreed that seatbelt use is important
and told Reuters Health she obeys the seatbelt law despite
difficulty.

"As a woman who's busty, the seatbelt rides up and strangles
me. But I wear my seatbelt, as does my sister, and we're both
clinically obese women," said Howell, who described herself as
close to 300 pounds.

Deb Burgard, California psychologist who specializes in
eating disorders, praised the study for calling attention to the
need for seatbelts that work for heavy drivers.

Burgard expressed concern, however, that the findings could
shift blame for not wearing seatbelts to obese people.

"I'm just wondering if this is going to lead to insurance
companies trying to charge fat people more," she said. "Are
police going to start profiling? What are the long-term
ramifications of a study like this?"

Jehle said he would like the study to prompt car
manufacturers to make longer belts and for safety regulators to
use larger dummies in crash tests.

"A lot of the crash studies are done on dummies that do not
fit in with our current population, which is one-third
overweight and one-third obese," he said. "When they sell you a
vehicle, they should sell it with all the equipment you need to
wear a seatbelt."